Maharlika Homes

Type of visit: Required - 1 Year

At 1:00 PM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met the staff Julieta Ranches who granted access to the facility. Administrator Designee Igmedio Gardose arrived at the facility shortly after. LPA explained the reason for the visit. Physical tour was conducted with the staff and LPA observed the following: It is a single story building with 5 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 4 nonambulatory residents. Approved hospice waivers for 2. LPA observed signs posted at the front for the facility’s visitation and masking policies. Additional postings inside included confidential complaint contacts, ombudsman contacts, emergency disaster plan, facility sketch, license, house rules, personal rights. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. Kitchen: At 1:05 PM, LPA observed an adequate supply of perishable and non-perishable food. The stove hood was clean and surfaces were sanitary. Sharps and cleaning solutions were locked below the sink. Medication: Medications: At approximately, 1:10 PM, LPA observed medications are centrally stored and locked in a locked cabinet in the living room. Bedrooms: The facility had 5 private bedrooms. One bedroom served as the staff room. The staff room was clean and free of hazards. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Continue on LIC 809C Bathrooms: The facility had 2 bathrooms. All bathrooms contained liquid soap, paper towels, bidets, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 1:15 PM, LPA measured the water temperature in the resident bathroom to be 115.4 degrees Fahrenheit. Common Areas: At 1:20 PM, LPA measured the room temperature to be 75 degrees Fahrenheit. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Laundry/ Garage: The laundry room and garage was adjacent to the staff room. Detergents were locked above the appliances. A fire extinguisher hung near the appliances. It was fully charged and last serviced on 05/12/2025. All emergency exit paths were free from obstructions. Exit gates were unlocked. Smoke detectors/carbon monoxide: At 1:25 PM, Administrator tested the living room smoke detector to be operational. LPA also tested the carbon monoxide detector to be operational. Outside areas: The outside area contained gardened spaces. The front yard contained a covered patio area with furniture in good condition. There is no swimming pool or any bodies of water. Between 1:30 PM to 02:30 PM, LPA reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, Administrator certificate, and LIC500. During today's inspection, the facility is in compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Dec 23, 2025

Allegation investigated: Licensee does not ensure bedbug issue is being handled in an appropriate manner.

At 9:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced subsequent complaint visit to investigate the above allegation. LPA met with Monique Gardose, the Administrator Designee, who granted access to the facility and LPA explained the reason for the visit. An initial visit was conducted on 03/21/2025. During today's visit, interviews and record review were made. At 9:40 AM, LPA requested residents and staff roster. At 9:50 AM, LPA conducted a physical plant tour. At 10:00 AM, LPA requested copies of pertinent information which include, but not limited to FENN Termit and Pest Control Invoices, receipts of newly purchased items, and etc relevant to the investigation. Between 10:10 AM – 11:30 AM, LPA conducted an interviews with the Administrator Designee, Staff #1 (S1) and three (3) out of four (4) residents avaliable to interview. Continue on LIC 9099C Unsubstantiated Licensee does not ensure bedbug issue is being handled in an appropriate manner. It’s alleged the facility has had bedbug issues for some time and are not seeking professional service for eradication/extermination. To investigate this allegation LPA conducted an interview with the Administrator Designee and S1 who confirmed that the facility did have bedbug issues only in R1’s room; however, it was treated and eradicated professionally and as well followed the proper protocol on a personal level by removing all infested items from R1’s room and placing them in a plastic bag to treat them. During the initial complaint visit on 03/21/2025, LPA observed all items being in a plastic bag and were placed outside of the facility which confirms the statement provided by the Administrator Designee and S1. The Administrator Designee also informed LPA that the infested mattress and bed were replaced with newly purchased bed and mattress for R1. Moreover, as a precaution the entire facility including all clients’ rooms were treated and sprayed four times with FENN Termite and Pest Control company in the month of March 2025. Document reviewed from FENN Termite and Pest Control company confirmed that the facility was inspected and treated for bedbugs during the month of March 2025. During facility's tour LPA observed four (4) residents rooms Including R1's room and all rooms were observed clean. Each bed, bedding, and mattresses were clean, and no bedbugs were observed. Lastly, during interviews with three (3) out of four (4) residents, all residents stated to have no concerns with bedbugs being in their rooms or in the facility. Therefore, based on interviews, record review, and LPA’s observation during initial complaint and today’s visit this allegation is deemed unsubstantiated at this time. An exit interview was conducted and a copy of the report signed and delivered.the state’s words, verbatim · CDSS document, May 13, 2025 · control 31-AS-20250313154140

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Huma Rahimi conducted unannounced visit to this facility in conjunction with a complaint control #31-AS-20250313154140. LPA was unable to gain access to the facility due to extermination spraying of the bedbugs at the facility. LPA contacted the Administrator Designee via telephone and explained the reason for the visit. During the visit, LPA was informed that the facility is infested with bedbugs for the past two weeks. However, no incident report was submitted to the Community Care Licensing Department (CCLD) in a timely manner. LPA reviewed all incident reports on a system and did not observe an Incident Report regarding bedbugs infestation. In addition, the Administrator Designee admitted that no incident was submitted to the Regional Office (RO). Based on Title 22 Regulation: a written Unusual Incident / Injury Report shall be submitted to CCLD within seven (7) days of occurrence. LPA informed the Administrator that all staff members are mandated reporters and they are all responsible for reporting. LPA informed the Administrator Designee to submit an incident report that occurred on or before : 02/28/2025 (one incident) Exit interview conducted, appeal rights and copy of report signed and delivered.the state’s words, verbatim · CDSS document, Mar 21, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)A,B&D · Plan of correction due date: Mar 28, 2025

Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency and to the person... ... any of the events specified in (A), (B) & (D)... This requirement is not met as evidenced by: Based on interview with the Administrator Desginee conducted by the LPA licensee did not comply with the section cited above by failing to notify CCLD regarding bedbug infestation at the faciliyt on or before 02/28/25, which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 21, 2025

Plan of correction: Licensee shall ensure a written report is submitted to the licensing agency and to the person responsible for the residents within seven (7) days of the occurrence of any of the events. The incident report shall be submitted to LPA by POC due date.

Type of visit: Required - 1 Year

At 11:00 AM, Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met with the Administrator Designee Monique Gardose. LPA explained the reason for the visit. Physical tour was conducted with the Administrator Designee and LPA observed the following: It is a single story building with 5 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 4 nonambulatory residents. Approved hospice waivers for 2. LPA observed signs posted at the front for the facility’s visitation and masking policies. Additional postings inside included confidential complaint contacts, ombudsman contacts, emergency disaster plan, facility sketch, license, house rules, personal rights. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. Kitchen: At 11:10 AM, LPA observed an adequate supply of perishable and non-perishable food. The stove hood was clean and surfaces were sanitary. Sharps and cleaning solutions were locked below the sink. Medication: Medications: At approximately, 11:12 AM, LPA observed medications are centrally stored and locked in a locked cabinet in the living room. Bedrooms: The facility had 5 private bedrooms. One bedroom served as the staff room. The staff room was clean and free of hazards. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bathrooms: The facility had 2 bathrooms. All bathrooms contained liquid soap, paper towels, bidets, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 11:15 AM, LPA measured the water temperature in the resident bathroom to be 119.3 degrees Fahrenheit. Continue on LIC 809C Common Areas: At 11:18 AM, LPA measured the room temperature to be 75 degrees Fahrenheit. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Laundry/ Garage: The laundry room and garage was adjacent to the staff room. Detergents were locked above the appliances. A fire extinguisher hung near the appliances. It was fully charged and last serviced on 04/26/2024. All emergency exit paths were free from obstructions. Exit gates were unlocked. Smoke detectors/carbon monoxide: At 11:45 PM, Administrator tested the living room smoke detector to be operational. LPA also tested the carbon monoxide detector to be operational. Outside areas: The outside area contained gardened spaces. The front yard contained a covered patio area with furniture in good condition. There is no swimming pool or any bodies of water. Between 12:00 PM to 01:30 PM, LPA reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, Administrator certificate, and LIC500. During today's inspection, the facility is in compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 13, 2025

Allegation investigated: Staff did not ensure medication was not accessible to residents in care Staff did not ensure a lid was on infectious waste garbage

At 11:30 AM, Licensing Program Analyst (LPA) Huma Rahimi conducted an unannounced initial complaint visit at this facility to investigate the above allegation. LPA met with Monique Gardose, the Administrator, who granted access to the facility and explained the reason for the visit. During course of the investigation, interviews and record review were made. At 11:45 AM, LPA requested client and staff roster. LPA requested copies of pertinent information which include, but not limited to an Approved Infection Control Plan, Medication Policy, Training, and etc. At approximately 11:50 AM, LPA conducted a physical plant tour. Between 12:00 PM – 1:00 PM, LPA interviewed the Administrator, one staff (S1), and one (1) resident out of four (4) who was available at the time of the visit. LIC 9099-C continued Substantiated Staff did not ensure medication was not accessible to residents in care: It was alleged that two prescribed medications (1) one tube of hydrocortisone and (1) one tube of Calmoseptive Ointment were accessible to residents in care. To investigate the above allegation, from 12:00 PM to 1:00 PM, LPA conducted interviews and reviewed documents pertaining to the allegation. Interviews with the Administrator and S1 confirmed that on June 11, 2024, a random unannounced visit was made by a credible witness who observed prescribed medication in the shower caddy in a resident's room accessible to resident in care. During today’s visit, LPA did not observe any prescribed/over the counter medications/vitamins left accessible to residents in care. Review of facility’s Medication Policy states that all prescribed and over-the-counter medications will be kept in a safe and locked place that is not accessible to residents in care. Based on the information gathered during the visit, the allegation is deemed SUBSTANTIATED. Staff did not ensure a lid was on infectious waste garbage: It was alleged that a trash can inside the main resident hallway bathroom was observed without a lid by a credible witness on June 11, 2024. To investigate the above allegation, LPA interviewed Administrator and it was discovered that two weeks prior of June 11, 2024, the trash can lid was broken and did not have a tight fitting lid. During today's visit, LPA toured the facility and observed that all trash cans do have lids. However, Administrator admitted to have a trash can with infectious waste without a lid prior to LPA's visit. Based on interview and observation this allegation is deemed Substantiated at this time. Citations issued. Appeals rights discussed and provided. Exit Interview conducted. A copy of this report provided to Administrator.the state’s words, verbatim · CDSS document, Jul 9, 2024 · control 31-AS-20240702152855

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Jul 10, 2024

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not met as evidenced by: Based on observation of a credible witness on 06/11/2024, the licensee did not comply with the section cited above to ensure that prescribed and PRN medication were kept locked and inaccessible to residents. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2024

Plan of correction: Administrator agreed to schedule vendorized medication training for all staff by 08/18/23 and submit to CCL the vendor information and scheduled date of training. Training certifications to be submitted to CCL upon completion.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(f)(3) · Plan of correction due date: Jul 16, 2024

87303 Maintenance and Operation (f) Solid waste shall be stored and disposed of as follows (3) All containers, except movable bins, used for storage of solid wastes shall have tight-fitting covers on the containers…This requirement is not met as evidence by: Based on interview and observation Administrator failed to have container with tight fitting lids. This poses a potential health and safety risk or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Jul 9, 2024

Plan of correction: Administrator purchased trash bins with lids prior to LPA visit. This POC is cleared.

Type of visit: Required - 1 Year

At 12:00 PM Licensing Program Analyst (LPA), Huma Rahimi, conducted an unannounced annual inspection at the facility mentioned above. LPA met the staff Julieta Ranches who granted access to the facility. LPA explained the reason for the visit. Administrator Designee Monique Gardose arrived at 12:18 PM and LPA explained the reason for the visit. Physical tour was conducted with the Administrator Designee and LPA observed the following: It is a single story building with 5 bedrooms, 2 bathrooms, kitchen, garage, common areas, and outdoor areas. It has an approved fire clearance for 4 nonambulatory residents. Approved hospice waivers for 2. LPA observed signs posted at the front for the facility’s visitation and masking policies. Additional postings inside included confidential complaint contacts, ombudsman contacts, emergency disaster plan, facility sketch, license, house rules, personal rights. Walls, floors, ceilings, windows, screens, and blinds were clean and in good repair. Kitchen: At 12:20 PM, LPA observed an adequate supply of perishable and non-perishable food. The stove hood was clean and surfaces were sanitary. Sharps and cleaning solutions were locked below the sink. Medication: Medications: At approximately, 12:25 PM, LPA observed medications are centrally stored and locked in a locked cabinet in the living room. Bedrooms: The facility had 5 private bedrooms. One bedroom served as the staff room. The staff room was clean and free of hazards. All bedrooms contained a chair, nightstand, lamp, storage, and bed with adequate bedding. All furnishings were clean and in good condition. Bathrooms: The facility had 2 bathrooms. All bathrooms contained liquid soap, paper towels, bidets, handwashing instruction sign, trash can with a tight fitting lid, grab bars near the toilet and shower, and a non-skid mat in the shower. At 12:35 PM, LPA measured the water temperature in the resident bathroom to be 111.4 degrees Fahrenheit. Continue on LIC 809C Common Areas: At 12:43 PM, LPA measured the room temperature to be 69 degrees Fahrenheit. The living room and dining area appeared clean and were properly furnished. The living room has a television, comfortable furniture. No obstructions and or tripping hazards throughout the facility. Laundry/ Garage: The laundry room and garage was adjacent to the staff room. Detergents were locked above the appliances. A fire extinguisher hung near the appliances. It was fully-charged and last serviced on 05/02/2023. All emergency exit paths were free from obstructions. Exit gates were unlocked. Smoke detectors/carbon monoxide: At 12:42 PM, Administrator tested the living room smoke detector to be operational. At 12:42 PM LPA also tested the carbon monoxide detector to be operational. Outside areas: The outside area contained gardened spaces. The front yard contained a covered patio area with furniture in good condition. Between 1:20 PM to 02:30 PM, LPA reviewed records of four (4) clients and two (2) staff. Client and staff records appeared to be complete and updated. Administrative: LPA collected Certificate of Liability Insurance, Administrator certificate, and LIC500. During today's inspection, the facility is in compliance with Title 22 regulations. Exit interview conducted. Copy of report provided.the state’s words, verbatim · CDSS document, Jan 4, 2024